Hi, I was just wondering how large a factor what medical school plays into getting a residency and job where you want. I realize getting into Harvard Med is a bigger deal than say Oakland University. But when you say apply to as many school as possible, is it simply the money issue that would prevent you from doing that, or is getting into a below average medical school that bad of a thing.

I’ll summarize it by saying, “Is there a best medical school?”

The U.S. News & World Reportrankings would have you think that there is a vast difference in the quality of medical schools here in the United States. Pre-meds, parents, and the media play into this frenzy of believing that certain schools are vastly superior to others. I’ve written in an earlier post on my feelings about the ranking methodology. Instead, I will use today to discuss whether or not there is any validity to these rankings.

First, consider performance on the licensing exams. All universities, on average, have a 95% pass rate for their students. That also means that there is, on average, a 5% failure rate. Both Harvard and Drexel each have students perform at the top of the bell curve as well as those who fail outright. While there are differences in the average score, your performance on the test is based solely upon your own preparation, and not any magical instruction given by the school.

I also found a list of people who have matched into plastic surgery in 2007 and neurosurgery in 2008. Take a moment to go through the names of all of the schools. You’ll notice a variety of universities are listed, including rank and unranked programs.

That’s not to say that where you go to medical school is completely meaningless. Residency program directors certainly take it into consideration. For example, if a senior resident from State University is doing well at a particular residency, the program director is likely to look favorably upon medical students applying from that university. The converse is true. If a resident who is an alum of your university is performing poorly, the program director might unconsciously think that you will struggle as well.

Some research has been performed on the subject as to what program directors are looking for. Several years ago the journal Academic Emergency Medicine published an article ranking the most important factors of an application. They are:

Chrissaid,

True, mostly. There are, however, some places that are stigmatized either for reputation or historical reasons. I went to a school where a couple interviews actually asked me how I’d ended up there and what I thought of it – spun it well, but it really showed me that there was a bias. Plus we’ve never matched in some highly competitive fields despite multiple attempts.

While I agree with the general idea that a student from any school who does well academically can match pretty much anywhere, I still think school reputation matters, albeit indirectly. The problem here is that the variables being listed are not independent from each other. If you go to a good medical school and get a good education and then do well on your boards, then your good board score will partially capture the value that the medical school imparted. Match rates are not necessarily as important as average board score or whether graduates go into their top or one of their top three choices.

Another way to look at this is, look at the top tier programs in a particular field. Are there students seemingly randomly distributed across medical schools, or clustered from a certain few? I think there is more clustering than what your post would imply.

Just my two cents.
-Scrub Notes

jwiscsaid,

It is important to realize that the end goal of a medical education is not the perfect match, but rather becoming the best physician possible. I think the stress that is put on going to a top tier medical school has some foundation albeit a poor one. The reason (hopefully and probably optimistically) we all are pursuing a career in medicine is to be able to have a direct impact on the well-being of those around us. Medical school choice should be based upon coherence with an individual’s learning style and the quality of teaching staff and ultimately for superb patient care. Again, I hope that I’m not delusional.

Medical school curriculum doesn’t vary. The same body of knowledge needs to be learned whether you’re in Cambridge, MA or Toledo, OH. Once you get renal physiology down, there’s nothing else to do with it. There are no honors courses or visiting professor seminars. You simply move on to the next topic. Medical school isn’t an open-ended situation that challenges students to go beyond the curriculum, like at elite undergrad colleges. You’re given x amount of information to learn and master and that’s all there is to it. After the first week of med school, I never went to another class. I basically home schooled myself using the syllabi and text books and noteservice as the guide. And I finished near the top of the class.

Residency is a different situation, especially for a surgeon. If you’re at a marginal residency program, you’re not going to be exposed to the kinds of patients and operations that someone at a good program would see. And with work hour reform… blah blah blah….I’ll stop right there..

GreenWeaversaid,

My two cents is that there is not a “best” medical school, but that there really might be a better medical school for YOU. I’m sure buckeye surgeon is essentially correct, but I think it’s in general difficult to know unless you have spent time really interacting at multiple medical schools. Based on my current experience at a school with two curricular paths that really are quite different, I’d say it sure can vary a lot, particularly in how material is presented. How you learn, and the extent to which you will be expected to learn on your own vs. having things really drilled into you seems to be pretty different just between our two programs. Also, different schools can offer you different kinds of exposures to research, service, shadowing, etc. Probably in the long run won’t make much difference in terms of residency, but could if you don’t do well because you’re at a school that fits you badly.

Notanopinionsaid,

DoubleDizzlesaid,

I would disagree with BuckeyeSurgeon – I think medical curricula vary quite a bit. Fortunately, the “classics” – such as the renal physiology he mentions – are available at any allopathic or osteopathic school. Heck, you can learn that sort of thing for “a buck twenty five in late charges from the public library” to quote Good Will Hunting. Guess what? I went to Hopkins and I got to learn renal physiology from Peter Agre – you know, the guy who discovered aquaporins, for which he won the Nobel prize. Guess what else? That has zero bearing on anything I’ve ever done as a physician and to this day I don’t think I can explain renal physiology any better for having learned all the excruciating details that “serious” research-oriented medical schools will force on you (and its not cause I played hookey – I was AOA). When you go to an elite reseach oriented medical school you will end your preclinical years (the first and most meaningless half of your MD) wondering what the hell you are paying for?
What you do get at an “elite” or “top tier” medical school that is worthwhile is a chance to interact one-on-one with exceptional clinicians – the opportunity to “retract for the stars” if you will. Medicine is a very practical field and most of the truly important information cannot be learned from a book. The best example of this is surgery. The majority of this type of training takes place in residency, but medical school is a profoundly important stepping stool to getting into the residency of your choice. And I would look at data rather than some random article in some Academic ED rag – 99% of journal articles in academic medicine are complete bullshit published so someone can make tenure, get a grant and see fewer patients in clinic.
Follow halfmd’s links to the Hopkins match list, for example, you’ll see almost all of the Hopkins neurosurgery spots over the past few years have gone to – you guessed it – Hopkins graduates. Look at MGH’s Radiology page and see where those guys went. Bottom line – you go to a state school and you have to be #1 in your class to get to work with the premier neurosurgeons or radiologists in the country. Go to Harvard, Hopkins, Penn, etc. and you can be one of two or three students from your class that stay on (the rest will go to other elite programs and cross-pollinate). For people like myself who have invested 20 plus years of their life into preparing for their career, this constitutes a huge difference. Since I was unwilling to leave my Match chances to fate, I decided it was worth the sacrifice to attend a place like Hopkins.
All of this essentially boils down to the fact that while the first two years of medical school can be learned from books, the majority of important medical knowledge must be learned from people – your piers, attendings, residents, fellows, etc. This is why there is such a profound variation in the adequacy of residency training programs. You will appreciate this the first time you rotate in a non-academic center like a VA or a community hospital and work with someone who went to a weak residency in the US or even worse trained in the Caribbean.
So here’s my advice – excellence begets excellence. Dig deep into your pockets (or, as is usually the case, someone else’s) and bet on yourself. If you want to be the best of your generation – train with the best of your generation.

thehillbillyhealersaid,

Engaging stuff guys, you’ve given me some pretty important stuff to think about. Half (or whoever knows) what would you say about USUHS? Think that’s as bad of a route as the HPSP? Don’t more USUHS grads get priority over HPSP when it comes to match as long as they have similar USMLE scores? Thanks for any feedback.

halfmdsaid,

I have a few friends who went to USUHS and liked it. I can’t say anything about it personally. The payback is 7 seven years—something to consider if you don’t have prior military experience and aren’t too sure about what you’re getting into. And no, USUHS grads do not have priority in the match.

stevenMsaid,

I had a couple of questions. I am currently in college pre med I have a good gpa and am a single parent of five children. One of my children has special needs. I want to be a Dr very badly but have a shaky past in which I got into some trouble but all before I had children. Should I classify my dream as just that or keep hot on its heels?

mbsaid,

Its a lot easier getting into a good residency from a good medical school:

more research opportunities
letters from “famous” docs
a home program that is good and favors you
well respected advisors making calls for you
residency programs comfortable taking applicants from your school…all that shit

Or you could be AOA and smoke the step 1’s and be fine, but that requires being AOA and smoking the step 1s.